Modern Living and the Myth of Lifelong Psychiatric Medication

“There is always soma, delicious soma, half a gramme for a half-holiday, a gramme for a weekend, two grammes for a trip to the gorgeous East, three for a dark eternity on the moon…”– Aldous Huxley

A few years ago, the World Health Organisation (WHO) projected that by 2020, every fourth Indian would be on antidepressants or anti-anxiety medication. The statistics got revised when the WHO declared that 7.5 percent of Indians suffer from mental illnesses. The real figure may be higher if other illnesses are added by strict clinical criteria. Cases of depression have been rising at 18 percent globally, and it’s now considered to be the number one silent killer. In India, the 2016 National Mental Health Survey suggested 150 million Indians suffered from mental illnesses, but only 30 million were being treated properly – which means one in 20 Indians suffers from depression. Add the problems children face today and we have a ticking time bomb. The survey also pointed towards disparate distribution of mental healthcare facilities, which are largely urban-centric, and paucity at all levels of care, be it in number of personnel or centres for treatment and rehabilitation.

The only assistance that India has a surplus of is the pill. We may well be on the path to becoming Prozac Nation 2. We are turning into a nation of high psychiatric morbidity and bad psychological health. If our population has mental baggage that it carries in daily affairs, the future may be bleak. But can an epidemic of psychiatric illnesses be similar to other illnesses such as diabetes? Are psychiatric illnesses a disease or a distress? Our society needs to examine their causative factors; the writing on the wall is clear: high levels of stress and a changed focus of people in a liberalized, global India. The rush for material success, where profit drives people rather than the pleasures of life, is an o -repeated discourse.

A reactive mental health industry has much to contribute. Overpowered by the global pharmaceutical industry, psychotropic medication is over-prescribed. In the absence of guidelines and a shortage of Psychiatrists, most clinics have 30 to 50 percent patients with psychiatric illnesses, and anyone can freely prescribe psychiatric medication. The lack of training sends rational psychopharmacology for a toss.

Part of this problem is organic to psychiatry. Unlike other medical disciplines, it does not look at causes (until very recently). Diagnoses are largely made on the phenomenology and syndromal descriptions. The drug treatment is very effective in ameliorating symptoms, thus creating an algorithmic exercise of mix and match. We have to wait for this fundamental change till neuroscience alters its approach. The pill remains a major weapon for doctors, while non-drug routes struggle to prove their efficacy.

But the real danger has socio-economic roots, and deeper ramifications. Human behaviour is culturally rooted and so are its problems. The prevalence of diseases may be universal but the medicalisation of life is a relatively new phenomenon. Anxiety is part of life, but to solve it with medical intervention is a short-cut. Affluence can lead to certain issues, while poverty may create a different set of issues. Hence the need to look beyond just the diagnosis and the drug.

The helplessness and stress of living in modern times, especially in crowded and resource- crunched countries, create symptoms mimicking illnesses. When religion and social buffers fail, hospitals step in. Impatience pushes doctors to label the ‘problems of living’ and ‘social suffering’ as illnesses. What in older times would have been handled with strength from inner, family or religious resources is now regarded as depression and anxiety. Such labelling of life’s conflicts takes away people’s coping abilities, and their minds take shelter under the umbrella of treatment. The myth of lifelong psychiatric medication emanates from a reluctance to let go of medicine’s crutches. The pertinent question should be, are we talking about mental health or mental illness? Or are we fallaciously confusing the lack of illness as health?

Mental health by WHO’s old definition is “a state of well-being in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.” The underlying theme is the unstated harmony between contradictory thoughts and situations, a focus that was highlighted in Eastern philosophy. The route to health was correct living (without being moralistic) – the attempt to prevent before the cure. Formative bricks had to be laid out in growing years through critical thinking in education and training. We have to understand the conditioning of the Indian mind within its own cultural and social context to help people differentiate between life issues and illnesses. Not just mental health professionals but intellectuals and scientists are responsible for breaking this down to the population.

We will have to question very soon whether we need to explore inherent mechanisms to stabilise our psyche or be ready to follow a Western model of life and disease. If we really wish to take pride in Indian and other Eastern traditions, we have to move beyond the rhetoric and delve deep to rediscover the psychotherapeutic elements within our culture, and integrate them with our modern scientific understanding of the mind and the brain. Only then will we be talking about mental health.

Problem with Psychiatry

People who fell out of defined normalcy of age – normalcy kept changing—criminal(intent) or mentally ill( involuntary) . Though abnormal behaviour in old times was relegated to astrology or ghosts.

The behaviour and their further course were labelled illness and these labels increased over times till DSM V.

The categories are nothing more than clusters of symptoms and  arbitrary  time durations

The tool of Psychiatry still remains phenomenology

• Labels on modes of thinking and feeling arising out of the basic human process of categorizing and labelling to make a meaning.
• The labels arose more out of philosophy and psychology rather than any objective proof.
• Subjective report pushed under the objective envelope by A professional taught in labelling.
• The limit and interface between normal and abnormal is often blurred
• No objective biological or neuroscientific basis is found till now.
• Each person with his internal world exists in best survival mode, just if it does not fit in the existing norms , it is mental illness.

Mental health is another ill defined concept plaguing the modern times but it poses a risk – any behaviour can be labelled as a poor mental health but what is the truth beyond fanciful concepts.

Amidst the dust of concepts Psychiatry and Psychologists try to treat and restore sanity.

Can we?

We try to correct a subjective world with objective means without any objective basis.

Even Neuroscience is being driven by definitions from age old Psychology even when the findings defy a clear-cut space-time for emotions, motivations, thought and many others, within the brain. A true understanding of the brain’s process is still out of reach though pieces are visible.

The technology of last 100 years like EEG and Imaging just provides us with an indirect data, infatuating the researchers with big data. But none specific to Mental Illnesses. So is with Genetics.

Yet Psychiatry is existing and is successful !!!

Because of

-our propensity to explain the problem of a person in a pseudo-scientific jargon.

-success of biochemistry and pharmacological enterprise that has given us molecules to target Neurotransmitters.

– The modulation of Neurotransmitters by external agents changes the brain state by altering electrical oscillations in brain.  The core of illness if any is this electrochemical play in the neuronal assemblies that keeps creating our mental states.

– we still do not understand fully the emergence of these states, not even to decide the ‘Normal’

– With the advent of labels and drugs corresponding to these labels we thrive. We may not know the complexity of the process but it works for the functional purpose and return  to a perceived normalcy in most (a subjective process)

– But return to normalcy is again subjective!

– Psychiatry through its scales and tools tries to quantify the two different states while Psychology  banks on the conceptual tools like psychotherapy to alter the subjective processes.

– Brain itself evolves through neuronal networks through external influences, conditioning in common terms, and retains its neuroplasticity. Reconditioning or re learning is the best we can define therapy as.

A difference between Neurology and Psychiatry is that the former deals with the structural and physiological problems with brain leading to various signs while latter deals with behaviours. Often, they overlap. 

Medicines try to change it from within, therapy from outside to various level of success.

The real problem does not come from Psychiatry but it limits the scope of Mental health professionals, a boundary they do not accept.

The Mind is yet undefined.  The debate between mind and brain is unresolved in spite of the Neuroscience progress. We are dealing with mind or brain is not taught to most professionals.

The field of mental health/illnesses thus becomes wide open for everyone – writers, spiritualists, religion and many others.

This also arises because behaviour has cultural, social, political, economic reasons too.

Psychiatry to be considered as scientific  will have to behave like a science and focus on its purview else it will face criticism.

The state is somewhat like Quantum Physics where few ‘ Shut up and calculate’ , convert it to technology rest guess and elaborate it to ‘quantum foolishness’  as ‘ No one understands what is quantum’ according to Feynman.

About the Author:

Dr. Alok Bajpai is a Psychiatrist trained at NIMHANS, Bangalore, working at Kanpur after few stints abroad. Apart from practicing Psychiatry, a consistent focus of his work is with children, adolescent and youth, being associated with various Institutes and schools. His work extends beyond the confines of clinic into freelance teaching of mental health issues and life skills. Psychiatry, Physics, Film, Music, Literature and Teaching are only some of the things that occupy Dr. Alok Bajpai’s wide world. He has been instrumental in putting together many awareness campaigns and workshops – especially with schools and has trained teachers – aiming at increasing sensitivity towards childhood problems, in many Indian cities.